Pediatric Behavior Management

1. Behavioral ManagementTechniques
for the Pediatric Dental Patient

2. Behavior Management

3. Behavior Management
•Goals of communication and education
•Process of dialogue, facial expression, and voice
tone
•Build a relationship between dentist and patient

5. To maintain compliance
• Skills of verbal guidance
• Expectation setting
• Extinction of inappropriate behavior
• Reinforcement of appropriate behavior

6. Objectives
•To effectively and
efficiently perform
treatment for the child
•To instill a positive
attitude

7. Behavior in the 2000’s
•Fewer children living in traditional family
setting
•Women: bearing less children and later in life
•Those living in family households: now less
stable, more heterogeneous

8. Pediatric Dental Triangle
• Patient should always be
your highest concern
• Continuum of interactions
between all three persons
Child
Parent Dentist

9. Behavior in the 2000’s
•> 50% of all children
likely to experience
living with a single
parent
•More organized
facilities here to meet
needs of employed
parents

10. Practice Parameters
•General dentists must follow same guidelines
as pediatric dentists
•If you do not have many patients who require
premed, cannot justify purchase of pulse
oximeters, precordial stethoscope, etc.

11. Practice Parameters
•Recent AAPD Work Force statistic: 80% of
dental procedures performed on children are
done by general dentists
•Good reason to become more adept with
behavior management skills

12. Dental Profession
• Professional profile is
changing
• Women have entered
profession in significant
numbers and may have a
different behavior
management style
• Insurance companies may
not approve conscious or
IV sedations

13. Dental Profession
• Society is more litigious
• Parents are not consenting
to physical and
mechanical restraints
• Dentist may be portrayed
as the abuser

14. Physical Restraint
• An example of protective
stabilization
• Will be discussed in depth
at a future lecture

15. Now is the time to reacquaint
ourselves to behavior
management skills

16. Communicative Management
• Used with both the cooperative and uncooperative
child
• Basis for establishing a relationship with the child to
allow successful completion of dental procedures
• Helps child to develop a positive attitude toward
dentistry

17. Cooperative vs. Uncooperative

18. Communicative Management
•Voice Control
•Nonverbal communication
•Tell-Show-Do
•Positive Reinforcement
•Distraction
•Parental Presence/Absence

19. Voice Control
•Controlled alteration of voice volume, tone or
pace to influence and direct the patient’s
behavior

20. Voice Control
•Note the proximity of
the dentist to the
patient

21. Voice Control
•To gain the patient’s attention and compliance
•To avert negative or avoidance behavior
•To establish appropriate adult-child roles

22. Nonverbal Communication
•The reinforcement and guidance of behavior
through appropriate contact, posture, and
facial expression

23. Nonverbal Communication
•To enhance the effectiveness of other
communicative management techniques
•To gain or maintain the patient’s attention
and compliance

24. Tell-Show-Do
•Tell: involves verbal explanations of
procedure in phrases appropriate to the
developmental level of the child

25. Tell-Show-Do
• Show: Demonstrations for
the patient of the visual,
auditory, olfactory, and
tactile aspects of the
procedure in a carefully
defined, non-threatening
setting

26. Tell-Show-Do
• “Showing” the procedure on
the child’s baby doll

27. Tell-Show-Do
•Do: Then, without
deviating from the
explanation and
demonstration,
completion of the
procedure

28. Tell-Show-Do
•To teach the patient important aspects of the
dental visit
•To shape the patient’s response to procedures
through desensitization and well described
expectations

29. Positive Reinforcement
• To establish desirable patient behavior it is essential to
give appropriate feedback
• Effective method to strengthen the occurrence of
desirable behavior

30. Positive Reinforcement
• Social reinforces include:
• Verbal praise
• Voice modulation
• Facial expression
• Appropriate physical demonstration of affection

31. Positive Reinforcement
• Non-social reinforces include:
• Tokens such as stickers
• Small toys

32. Positive Reinforcement
•The primary goal is to reinforce desired
behavior

33. Distraction
• Technique of diverting the patient’s attention from
what may be perceived as an unpleasant procedure
• Used to increase attention span
• Giving a child a hand mirror to hold while a dental
procedure is being done

34. Distraction
Sunglasses to block
out the intensity of
the light as well as
being protective

35. Distraction
• To decrease the perception of unpleasantness
• To avert negative or avoidance behavior

36. Parental Presence/Absence
• Technique involves using the presence or absence of
parent to gain cooperation for treatment
• Wide diversity exists in practitioner philosophy and
parental attitude regarding parents’ presence or absence

37. Parental Presence/Absence
Would you want this parent
watching over you while
you treated his son?????

38. Parental Presence/Absence
• Communication between dentist and child is paramount
• Communication demands focus on the part of both
parties
• Children’s responses to parents’ presence may be
beneficial or detrimental

39. Pediatric DentalTriangle
Child
Parent Dentist
Presence could be beneficial or
detrimental

40. Language may be a
barrier to
communication with
the dentist so
parental presence is
needed.
Parental Presence/Absence

41. Parental Presence/Absence
“I told him you were an ice cream
vendor. You take it from there.”

42. Parental Presence/Absence
• Each dentist needs to determine the communication
methods that best optimize the treatment setting
• Recognize his/her own skills
• Recognize the abilities of the child
• Desires of the specific parent involved

43. Parental Presence/Absence
• Gain the patient’s
attention and compliance
• Avert negative or
avoidance behaviors
• Establish appropriate
child-adult roles

44. Parental Presence/Absence
• One of the most controversial issues in pediatric
dentistry
• Generally speaking, pediatric dentists keep them out
• Generally speaking, pediatricians keep them in

45. Parental Presence/Absence
• For parental absence:
• Tend to repeat requests
• Become upset if child misbehaves
• Attempt to draw you in conversation
• May “test” you

46. Parental Presence/Absence
• For presence:
• Can become a “silent”
helper
• Good educational tool

47. Parental Presence/Absence
• Let the parent know:
• The child is the focus of your attention
• Questions will be answered either pre- or post-
treatment

48. Establishing Communication and
Authority
•Your main goal should be to prevent
uncooperative behavior
•Need to listen to child’s questions
•Acknowledge by repeating them back
•Also need to establish authority

49. Effective Dentists
•Establish rules for patients to follow
•Teach their patients
•Demonstrate kindness